Robert Francis QC made 290 recommendations for the NHS in light of the scandal

With families of people who died at Mid Staffs watching from the public gallery, he spoke of his "great affection" for the NHS, praising doctors and other staff.

But he added: "We do them a huge disservice if we fail to speak out when things go wrong."

What had happened was "not just wrong, it was truly wrong," he said.

In a sombre address invoking his appearances after the Bloody Sunday and Hillsborough reports, Cameron apologised for the way the system had allowed "horrific abuse to go unchecked and unchallenged" for so long.

He said: "On behalf of the government, and indeed of the country, I am truly sorry."

There had been a focus on "finances and figures" and "narrow, top-down targets", he told MPs, as well as "a culture of only explaining the positives".

Cameron echoed the report's view that the Royal College of Nursing had been "ineffective", and admitted the Department of Health had been "too remote."

Announcing reforms to the way hospitals are inspected, the Prime Minister said local NHS boards would be suspended for a lapse in care as well as financial mismanagement.

Patients and staff will be asked for feedback, with "immediate action" if it is negative, while nurses' pay could be performance-related in the future.

The Prime Minister confirmed that a new post of Chief Inspector of Hospitals is being created from the autumn, while immediate investigations will be launched into the hospitals with the worst death rates.

Improvements to whistle-blowing and complaints-handling procedures have also been pledged.

Coming straight after a lively Prime Minister's Questions, it was a non-partisan exchange with the opposition benches.

Labour leader Ed Miliband said the scandal was not typical of our NHS, saying most staff were "as horrified as all of us" by what happened.